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PubMed1980

Effects of modification of conceptual tempo on acquisition of work skills.

This study investigated the effects of modification of conceptual tempo on the skilled performance of a group of mildly intellectually handicapped adolescents receiving training in a work preparation centre (N, 41). On the basis of performance on Kagan's Matching Familiar Figures Test the group was divided into two subgroups, reflective, impulsive and then further divided through random allocation to control and experimental conditions. The two experimental groups received a training program designed to promote self-generation of strategies, using self-verbalization to induce a more reflective approach. The control groups received the normal training program of the centre. The criterion measure taken at pre- and posttest was a collation task standardized so as to provoke response uncertainty. Analysis of residual gain scores derived from the two testing occasions indicated that the experimental groups improved significantly more than the controls and that the improvement generalized to their performance on the Porteus Maze and Matching Familiar Figures Test. Contrary to expectation, however, the effect of training did not bring about significant differential improvement for impulsive as against reflective subjects. Both benefited from the training. On the basis of delayed posttests, no generalization was apparent.

Adolescent↗

PubMed2006

Sex differences in cognitive abilities test scores: a UK national picture.

BACKGROUND AND AIMS: There is uncertainty about the extent or even existence of sex differences in the mean and variability of reasoning test scores ( Jensen, 1998; Lynn, 1994, ; Mackintosh, 1996). This paper analyses the Cognitive Abilities Test (CAT) scores of a large and representative sample of UK pupils to determine the extent of any sex differences. SAMPLE: A nationally representative UK sample of over 320,000 school pupils aged 11-12 years was assessed on the CAT (third edition) between September 2001 and August 2003. The CAT includes separate nationally standardized tests for verbal, quantitative, and non-verbal reasoning. The size and recency of the sample is unprecedented in research on this issue. METHODS: The sheer size of the sample ensures that any sex difference will achieve statistical significance. Therefore, effect sizes (d) and variance ratios (VR) are employed to evaluate the magnitude of sex differences in mean scores and in score variability, respectively. RESULTS: The mean verbal reasoning score for girls was 2.2 standard score points higher than the mean for boys, but only 0.3 standard points in favour of girls for non-verbal reasoning (NVR), and 0.7 points in favour of boys for quantitative reasoning (QR). However, for all three tests there were substantial sex differences in the standard deviation of scores, with greater variance among boys. Boys were over represented relative to girls at both the top and the bottom extremes for all tests, with the exception of the top 10% in verbal reasoning. CONCLUSIONS: Given the small differences in means, explanations for sex differences in wider domains such examination attainment at age 16 need to look beyond conceptions of 'ability'. Boys tend to be both the lowest and the highest performers in terms of their reasoning abilities, which warns against the danger of stereotyping boys as low achievers.

Achievement↗

PubMed2006

Confidence-based active learning.

This paper proposes a new active learning approach, confidence-based active learning, for training a wide range of classifiers. This approach is based on identifying and annotating uncertain samples. The uncertainty value of each sample is measured by its conditional error. The approach takes advantage of current classifiers' probability preserving and ordering properties. It calibrates the output scores of classifiers to conditional error. Thus, it can estimate the uncertainty value for each input sample according to its output score from a classifier and select only samples with uncertainty value above a user-defined threshold. Even though we cannot guarantee the optimality of the proposed approach, we find it to provide good performance. Compared with existing methods, this approach is robust without additional computational effort. A new active learning method for support vector machines (SVMs) is implemented following this approach. A dynamic bin width allocation method is proposed to accurately estimate sample conditional error and this method adapts to the underlying probabilities. The effectiveness of the proposed approach is demonstrated using synthetic and real data sets and its performance is compared with the widely used least certain active learning method.

Algorithms↗

PubMed1989

Control-related cognitions and depression among inpatient children and adolescents.

In previous studies, children with numerous depressive symptoms have shown two patterns of control-related cognition: (1) low levels of perceived personal competence, and (2) "contingency uncertainty"--confusion regarding the causes of significant events. The generality of these findings was tested for more seriously disturbed children. Three child inpatient samples, from separate psychiatric hospitals, completed the Children's Depression Inventory (CDI) plus measures of control-related beliefs. In all three samples, the findings resembled those of previous studies: CDI scores were significantly related to low perceived competence and to contingency uncertainty; by contrast, CDI scores were only weakly related to perceived noncontingency. The findings suggest that depressive symptoms in children may be (1) more closely linked to "personal helplessness" than to "universal helplessness," and (2) more closely linked to uncertainty about the causes of events than to firm beliefs in noncontingency. The findings carry implications for etiology and treatment of child depression.

Adolescent↗

PubMed2006

A validated clinical and biochemical score for the diagnosis of acute heart failure: the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Acute Heart Failure Score.

BACKGROUND: No method integrating amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing with clinical assessment for the evaluation of patients with suspected acute heart failure (HF) has been described. METHODS: Amino-terminal pro-brain natriuretic peptide results and clinical factors from 599 patients with dyspnea were analyzed. The beta coefficients of the 8 independent predictors of HF were used to assign a weighted integeric score for predictor. The sum of these integers provided a diagnostic HF "score" for each patient. Receiver operating characteristic curve analysis determined the optimal cut point for the diagnosis of acute HF. The performance of the score was evaluated in the development cohort and subsequently in a patient population from a separate clinical trial of patients with dyspnea conducted in Christchurch, New Zealand. RESULTS: Eight factors comprised the score: elevated NT-proBNP (4 points), interstitial edema on chest x-ray (2 points), orthopnea (2 points), absence of fever (2 points), loop diuretic use, age > 75 years, rales, and absence of cough (all 1 point). Median scores in patients with acute HF were higher than those without acute HF (9 vs 3 points, P < .001). At a cut point of > or = 6 points, the score had a sensitivity of 96% and a specificity of 84% for the diagnosis of acute HF (P < .001). The score improved diagnostic accuracy over NT-proBNP testing alone and retained discriminative capacity in patients in whom clinical uncertainty was present. Lastly, the accuracy of the score was validated in the external data set of patients with suspected acute HF. CONCLUSION: We report a simple and accurate scoring system combining NT-proBNP testing and clinical assessment for the diagnosis or exclusion of acute HF in patients with dyspnea.

Acute Disease↗

PubMed2005

Paternal reactions to a child with epilepsy: uncertainty, coping strategies, and depression.

AIM: This paper reports a study examining the stress that fathers experience when caring for a child with epilepsy. BACKGROUND: A seizure, which is frightening and potentially damaging, creates uncertainty about its possible effects and threatens the integrity of family systems. In the Chinese social context, epilepsy is stereotyped 'sudden craziness' of people and affected family feel shamed by the diagnosis. When a child has epilepsy, the stereotype of epilepsy affects the family experience in terms of stress and their coping process. Few studies have focused on how a father with an ill child adapts to family stress. METHODS: This study was based on the resiliency model of family stress, adjustment, and adaptation, and was designed to examine the relationships among fathers' uncertainty, coping strategies, and depression. From three teaching hospitals in Taiwan, 210 fathers were recruited. A pilot study was conducted to establish the reliability and face validity of the Chinese language version of the Coping Health Inventory for Parents. FINDINGS: Results showed that paternal uncertainty was negatively associated with the total Coping Health Inventory for Parents score for family coping patterns for factors I, II, and III. Uncertainty and coping strategies for factors II and III were indicators of paternal depression and accounted for 10.3% of the total variance. CONCLUSIONS: The results give insight into the unique family stress that fathers experience as a result of the interaction between the social context of a child with epilepsy and the family's coping patterns. They also suggest ways to improve family-centred nursing interventions to help parents establish effective caring patterns to manage the family stress.

Adaptation, Psychological↗

PubMed1999

Interpreting the judgment of surgical faculty regarding resident competence.

BACKGROUND: It is reasonable to propose that competence is a multifaceted characteristic defined in part by some minimum level of knowledge and skill. In this study we examined the relationship between surgical faculty's judgment of clinical competence, as measured by a surgical resident objective structured clinical examination (OSCE), and the residents' objective performance on the skills being tested. METHODS: Fifty-six general surgery residents at all levels of training participated in a 30-station OSCE. At the completion of each station, the faculty proctor made several overall judgments regarding each resident's performance, including a global judgment of competent or not competent. The competence judgment was applied to the objective percentage performance score in three different ways to construct methods for determining competence based solely upon this objective percentage score. RESULTS: The average mean competent score (MCS) across the stations was 61%, and the average mean noncompetent score (MNCS) was 38%. The difference between MCS and MNCS for each station was very consistent. Upper threshold scores above which a judgment of competent was always made, and lower threshold scores below which a judgment of noncompetent was always made were observed. Overall, the average mean and threshold scores for competent and noncompetent groups were remarkably similar. For performance scores in the range between the threshold competent and noncompetent scores at each station, measures other than objective performance on the skills being evaluated determined the judgment of competent or not competent. CONCLUSIONS: Empirically determined minimum acceptable standards for objective performance in clinical skills and knowledge appeared to have been subconsciously applied to the competence judgment by the faculty evaluators in this study. Other factors appeared to have become determinate when the objective performance score fell within a range of uncertainty.

Animals↗

PubMed1995

The Chernobyl accident and mental wellbeing--a population study.

We studied the long-term effects of the 1986 Chernobyl nuclear power plant accident on mental wellbeing 7 years after the event. Mental wellbeing was assessed using a 12-item General Health Questionnaire (GHQ). The study group comprised 325 persons (aged 15-54 years) who had continued to live in the high-fallout area in Bryansk, Russian Federation, classified as a strict control zone with respect to the level of fallout and subsequent radiation protection countermeasures. The control group comprised 278 persons living in a noncontaminated area. The mental wellbeing of women in the study group was poorer than in controls (age-adjusted means). Based on the GHQ score, a minor mental disorder was detected in 48% of the women in the study group and 34% of the female controls. The corresponding figures for men were 26% and 28%, respectively. Those living with a partner coped better mentally than the others. The level of education was not associated with the GHQ score. Poor financial situation and self-rated poor health were associated with a high GHQ score. Fifty-nine per cent of the study group and 14% of the control group wanted to move away from the area of residence, but it was not associated with GHQ score. In a logistic regression analysis, independent factors explaining the GHQ score in the study group were uncertainty about the future in the men and, in addition, poor financial situation and insufficient social support in the women. According the results, the Chernobyl nuclear power plant accident impaired the long-term mental wellbeing of women living in the contaminated area.

Adaptation, Psychological↗

PubMed1981

Nursing subunit technology: a replication.

Overton, Schneck, and Hazlett's (1977) measurement of nursing subunit technology was replicated using 157 subunits of 9 types located in 24 hospitals in Alberta. A 21-item questionnaire was given to nurses, and the answers were subjected to factor analyses. Results indicated three dimensions of technology: instability, uncertainty, and variability. Because of the similarity of these variables to those in the Overton, Schneck, and Hazlett study, the results suggested a high degree of construct validity for the measure. The technological dimensions also differentiated among the types of subunits in the same pattern as in the original study. A relatively quick method of obtaining measures of instability, uncertainty, and variability by using composite scores was tested and found reliable.

Alberta↗

PubMedDate not supplied

A critical survey of fish measurements in populations of the southern Urals.

A critical survey of all published measurements made so far aimed at retrospective biological dosimetry using fluorescence in situ hybridisation (FISH) techniques on some workers at the Mayak reprocessing plant and on members of the Techa River cohort is given. Each individual has a recorded dose derived from personal monitoring measurements, usually external gamma-rays for Mayak workers or from reconstruction techniques, usually internally derived for the Techa River cohort. From the person's age, which affects the control level, and the stated dose, an expected number of translocations is calculated for each individual and comparisons made to the observed numbers of translocations. From this, an assessment of how well FISH studies can help to validate existing estimates of dose is made. This varies from study to study. Good agreement is generally obtained for the Techa River cohort and lower doses of the Mayak cohort. Rather poorer agreement applies to the more highly exposed Mayak workers. Some of the discrepancy could be because the FISH painting technique was new and was applied to populations before a proper investigation on how to use it for retrospective biological dosimetry had taken place. In addition, too few cells were generally scored per individual so that statistical uncertainties were large.

Aged↗

PubMed2006

Factors related to meaning of life in Taiwanese women treated with in vitro fertilization.

BACKGROUND/PURPOSE: The meaning of life can be defined as a sense of a clear aim in life and a belief that one's daily activities are meaningful. Pregnancy is clearly an important aim of women who undergo in vitro fertilization (IVF) treatment. The purpose of this study was to evaluate the meaning of life and its related factors among women who underwent IVF treatment throughout the first treatment cycle until either pregnancy was achieved or when the attempt was abandoned. METHODS: This cross-sectional study was performed in a single medical center in Taiwan. A total of 149 subjects were recruited from women receiving IVF (n = 69) and women who had experienced IVF failure within the previous 1 year (n = 80). These women were classified into four subgroups according to their treatment stages: beginning of first IVF (n = 39); pregnancy/delivery (n = 22); continuing treatment (n = 64); and discontinuing treatment (n = 24). The Purpose in Life (PIL) test, a previously developed instrument designed to measure meaning of life, was administered to all patients at their follow-up IVF visit. RESULTS: The mean PIL score was 99.1 +/- 19.5, which indicated that all subjects had some degree of uncertainty regarding the meaning of life; however, no significant difference in PIL score was found among the four groups. Four factors were extracted from PIL by factor analysis, among which "existential frustration" (factor 4) was highest in the continuing group and those with a lower level of education; whereas "being in control" (factor 2 ) was lowest in women whose infertility had a female etiology. CONCLUSION: Treatment stage, educational level, and etiology of infertility were found to be factors influencing the meaning of life in women undergoing IVF.

Adult↗

PubMed2000

Young women with physical disabilities: risk factors for symptoms of eating disorders.

Women with disabilities are at risk for poor psychological adjustment and unhealthy weight-control practices. This study was conducted to determine the prevalence of symptoms of eating disorders in a clinic-based sample of women who had two disabling conditions and to identify condition-related risk factors that were linked to these symptoms. A cross-sectional survey of 71 women (mean age = 23 yr) with spina bifida or rheumatologically related illnesses was conducted to assess the symptoms of eating disorders, condition-related characteristics, and weight-control practices. Symptoms of eating disorders were measured by the Eating Disorders Inventory (EDI). Eight percent of the respondents reported a sufficient number of symptoms of eating disorders to indicate a possible clinical disorder. More than 20% of the respondents scored at or above the clinical cut-point on at least one of the eight EDI subscales. Selected condition-related characteristics (multiple conditions, condition-affected driving, and uncertainty of illness course) were associated with EDI scores after adjusting for demographic variables, family factors, and weight-control practices.

Adolescent↗

PubMedDate not supplied

An international comparison of physicians' judgments of outcome rates of cardiac procedures and attitudes toward risk, uncertainty, justifiability, and regret.

OBJECTIVE: Compare U.K. and U.S. physicians' judgments of population probabilities of important outcomes of invasive cardiac procedures; and values held by them about risk, uncertainty, regret, and justifiability relevant to utilization of cardiac treatments. DESIGN: Cross-sectional study. SETTING: University hospital and VA medical center in the United States; two teaching hospitals in the United Kingdom. PARTICIPANTS: 171 housestaff and attendings at U.S. teaching hospitals; 51 physician trainees and consultants at U.K. hospitals. MEASURES: Judgments of probabilities of severe complications and deaths due to Swan-Ganz catheterization, cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG); judgments of malpractice risks for case vignettes; Nightingale's risk-aversion instrument; Gerrity's reaction-to-uncertainty instrument; questions about need to justify decisions; responses to case vignettes regarding regret. RESULTS: The U.S. physicians judged rates of two bad outcomes of cardiac procedures (complications due to cardiac catheterization; death due to CABG) to be significantly higher (p < or = 0.01) than did the U.K. physicians (U.S. medians, 5 and 3.5, respectively; U.K. medians 3 and 2). The median ratio of (risk of malpractice suit I error of omission)/(risk of suit I error of commission) judged by U.K. physicians, 3, was significantly (p=0.0006) higher than that judged by U.S. physicians, 1.5. The U.K. physicians were less often risk-seeking in the context of possible losses than the U.S. physicians (odds ratio for practicing in the U.K. as a predictor of risk seeking 0.3, p=0.003). The U.K. physicians had significantly more discomfort with uncertainty than did the U.S. physicians, as reflected by higher scores on the stress scale (U.K. median 48, U.S. 42, p=0.0001) and the reluctance-to-disclose-uncertainty scale (U.K. 40, U.S. 37, p < 0.0001) of the Gerrity instrument. There was no clear international difference in perceived need to justify decisions, or in regret. CONCLUSIONS: The results were not clearly consistent with the uncertainty hypothesis that international practice variation is due to differences in judged rates of outcomes of therapy or with the imperfect-agency hypothesis that practice variation is due to differences in physicians' personal values. The causes and implications of practice variations remain unclear.

Angioplasty, Balloon, Coronary↗

PubMed2005

Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.

CONTEXT: Current use of cranial computed tomography (CT) for minor head injury is increasing rapidly, highly variable, and inefficient. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) are previously developed clinical decision rules to guide CT use for patients with minor head injury and with Glasgow Coma Scale (GCS) scores of 13 to 15 for the CCHR and a score of 15 for the NOC. However, uncertainty about the clinical performance of these rules exists. OBJECTIVE: To compare the clinical performance of these 2 decision rules for detecting the need for neurosurgical intervention and clinically important brain injury. DESIGN, SETTING, AND PATIENTS: In a prospective cohort study (June 2000-December 2002) that included 9 emergency departments in large Canadian community and university hospitals, the CCHR was evaluated in a convenience sample of 2707 adults who presented to the emergency department with blunt head trauma resulting in witnessed loss of consciousness, disorientation, or definite amnesia and a GCS score of 13 to 15. The CCHR and NOC were compared in a subgroup of 1822 adults with minor head injury and GCS score of 15. MAIN OUTCOME MEASURES: Neurosurgical intervention and clinically important brain injury evaluated by CT and a structured follow-up telephone interview. RESULTS: Among 1822 patients with GCS score of 15, 8 (0.4%) required neurosurgical intervention and 97 (5.3%) had clinically important brain injury. The NOC and the CCHR both had 100% sensitivity but the CCHR was more specific (76.3% vs 12.1%, P<.001) for predicting need for neurosurgical intervention. For clinically important brain injury, the CCHR and the NOC had similar sensitivity (100% vs 100%; 95% confidence interval [CI], 96%-100%) but the CCHR was more specific (50.6% vs 12.7%, P<.001), and would result in lower CT rates (52.1% vs 88.0%, P<.001). The kappa values for physician interpretation of the rules, CCHR vs NOC, were 0.85 vs 0.47. Physicians misinterpreted the rules as not requiring imaging for 4.0% of patients according to CCHR and 5.5% according to NOC (P = .04). Among all 2707 patients with a GCS score of 13 to 15, the CCHR had sensitivities of 100% (95% CI, 91%-100%) for 41 patients requiring neurosurgical intervention and 100% (95% CI, 98%-100%) for 231 patients with clinically important brain injury. CONCLUSION: For patients with minor head injury and GCS score of 15, the CCHR and the NOC have equivalent high sensitivities for need for neurosurgical intervention and clinically important brain injury, but the CCHR has higher specificity for important clinical outcomes than does the NOC, and its use may result in reduced imaging rates.

Adolescent↗

PubMed2006

A probabilistic model for the MRMC method, part 1: theoretical development.

RATIONALE AND OBJECTIVES: Current approaches to receiver operating characteristic (ROC) analysis use the MRMC (multiple-reader, multiple-case) paradigm in which several readers read each case and their ratings (or scores) are used to construct an estimate of the area under the ROC curve or some other ROC-related parameter. Standard practice is to decompose the parameter of interest according to a linear model into terms that depend in various ways on the readers, cases, and modalities. Though the methodologic aspects of MRMC analysis have been studied in detail, the literature on the probabilistic basis of the individual terms is sparse. In particular, few articles state what probability law applies to each term and what underlying assumptions are needed for the assumed independence. When probability distributions are specified for these terms, these distributions are assumed to be Gaussians. MATERIALS AND METHODS: This article approaches the MRMC problem from a mechanistic perspective. For a single modality, three sources of randomness are included: the images, the reader skill, and the reader uncertainty. The probability law on the reader scores is written in terms of three nested conditional probabilities, and random variables associated with this probability are referred to as triply stochastic. RESULTS: In this article, we present the probabilistic MRMC model and apply this model to the Wilcoxon statistic. The result is a seven-term expansion for the variance of the figure of merit. CONCLUSION: We relate the terms in this expansion to those in the standard, linear MRMC model. Finally, we use the probabilistic model to derive constraints on the coefficients in the seven-term expansion.

Analysis of Variance↗

PubMed1999

Heart failure: living with uncertainty.

Uncertainty has been identified as a significant part of the experience of heart disease and yet no studies have fully explored the experience of uncertainty in persons living with chronic heart failure. The purpose of this study was to describe the uncertainty experienced by men and women with heart failure and to extend the theoretical understanding of uncertainty in chronic illness. Qualitative inquiry was the interpretive approach guiding this study. Data were collected from 22 adults living in urban and rural areas of a rural western state and included audio taped interviews, clinical and demographic information, and scores from the community form of the Mishel Uncertainty in illness Scale (MUIS-C). Three major themes of uncertainty were identified related to symptoms and treatment, attempts to stay well, and quality of life and death. Unique contributions to the uncertainty in illness theory provided by this study include the influence of age related changes on the ability to recognize and respond to symptoms and the presence of cautious trust of health care providers. Nursing implications and recommendations for further study are discussed.

Adaptation, Psychological↗

PubMed2006

Characterizing the risks to aquatic ecosystems: a tentative approach in the context of freshwater dredged material disposal.

The development of relevant frameworks for assessing ecological risks posed by dredged material management does not only involve an appropriate selection of assessment and measurement endpoints but also requires a sound approach to both risk characterization and the associated uncertainty. A formal methodology addressing both aspects has been developed in France for freshwater sediment deposits in water. Both exposure and effects measurements are 1st transformed into scores or classes. As far as possible, class boundaries are based on existing knowledge or expertise. Benthic organism exposure is based on a ratio of the deposit area to the burrow pit area, whereas pelagic species exposure is based on the ratio of porewater volume to water column volume. The combination of exposure and effect scores yields risk scores, or classes, which are linked to management decisions. Uncertainty is assessed with respect to a set of 4 predetermined criteria for exposure (the strength of association with the assessment endpoint, spatial and temporal representativeness, and the use of standard methods) and 4 criteria for effects (strength of association, the distinction between effect and no effect, sensitivity, and the use of standard methods). This approach was applied to 8 sediments from French canals contaminated to varying degrees.

Animals↗

PubMed1993

The impact of unemployment on psychosomatic symptoms and mental well-being.

The relationship between psychosomatic symptoms and mental well-being among unemployed (N = 132) and employed (N = 187) personnel of two similar wood-processing factories was studied. Mental well-being was measured by means of the 12-item General Health Questionnaire (GHQ-score) and the 13-item Beck Depression Inventory (BDI-score). The 13-item questionnaire assessing psychosomatic symptoms was used (PS-score). The 33 and 66 percentiles (tertiles) were formed on the basis of PS-score of the two groups separately. The highest PS-score percentile was compared with the combined first and second percentile. Higher PS-score implied impaired mental well-being especially in the unemployed but also in the control group. Insufficient social support and uncertainty about the future was associated with highest PS-score in the study group but not in the control group. High PS-score was associated with subjective mental problems in both groups. Impaired health and PS-score were associated in both groups. Our results suggest that unemployment is a powerful external stress factor and that psychosomatic symptoms were associated with impaired mental well-being.

Adaptation, Psychological↗